July 7, 2007 - Irish Medical News
Ireland needs to look at ways to increase the number of kidney donations for transplantation.
"Our kidney donor waiting list will only continue to grow unless we develop the live donor programme," says Dr Catherine Wall, a consultant nephrologist at Dublin’s Tallaght Hospital. This country must look at ways of dialysing patients better because patients are going to be waiting longer for kidneys.
Dr Wall told IMN that Ireland will also have to look at how we are going to increase the number of organs for transplantation.
“At the moment we only take heart beating donor kidneys so we would be looking at increasing the cadaver donor rate by looking at the option of taking kidneys from non-heart beating donors,” she said.
This would be from people who have had an arrest outside the hospital environment. “We know these kidneys wouldn’t last that long but it is a very suitable resource for patients who are very elderly or you could put two kidneys in at one time so you could dose a patient with a larger amount of kidney tissue so there is a longer chance of the kidney surviving,” she added.
Dr Wall was speaking to IMN at the Irish Kidney Associations’ AGM last week. The key, she said is to look at developing the live donor programme which is some two years behind schedule at Dublin’s Beaumont Hospital.
According to Dr Wall, a donation by a spouse means transplantation can be done preemptively and therefore could avoid dialysis altogether for a patient.
She said developing a formal donor registry will also address a shortage in donations.
In the UK some 14 million people have registered to say they would be interested in donating organs. In the UK the family of a donor has no legal right to veto their decision if a patient has registered their interest.
While Dr Wall said the Irish Kidney Association “are wonderful advocates” for people with end-stage kidney disease “maybe we should be shifting focus on the fact that anything up to one in 10 Irish people have some form of kidney disease”.
She said often the disease is asymptomatic and that many patients only present very late in their disease.
“We should be pushing screening, identifying kidney disease earlier and looking at secondary prevention. Also we should be looking at primary prevention from the Department of Health and departments of public health and identifying and minimizing risk factors that lead to kidney disease in the first place, like obesity, diabetes, hypertension, diet and exercise,” she said.
Last year in the UK, some 2,800 kidney transplants were performed and some 700 of those were from live donors.
According to Dr Wall Ireland should be emulating that pattern. “The philosophy from Beaumont is to develop a very good live donor programme. The surgeons and physicians are on board but unfortunately it is two years behind schedule. In my own experience I’ve probably sent 12 people for listing for transplant in the last four months and at least half of them have a family member interested in donating a kidney. Our waiting list is going to grow unless we get the live donor programme up and running.”
Dr Wall estimates that there will be 10 to 15 per cent more patients coming to dialysis every year for the next five years so that by 2011, some 3,000 patients will be on dialysis.
She said we should be looking at home-based therapy “because everything we do should be patient centred.
“The data is out there that if you are on home-based therapy you live for longer and you feel better. It is partly about decluttering our hospitals but more importantly it is about giving patients back their independence and their life.”
Ireland currently has 1,500 patients on dialysis. Some 85 per cent of those patients are on haemodialysis with the remaining 15 per cent on peritoneal dialysis.
“What we’re aspiring to as a community of nephrologists and patients is that we would shift the focus away from hospital- based therapies to delivering therapies in the community,” said Dr Wall.
A big change in dialysis will be the introduction of home haemodialysis where patients will dialyse for four hours three times per week and Dr Wall said what she would really like to see is nocturnal home heamodialysis where the patient can dialyse between six and eight hours about five nights per week.
“For me the gold standard would be to deliver home-based therapies to patients where they want them. For us that should be a priority. Getting people out of hospital is better for patients. There are fewer infections, better cardiac outcomes, fewer medications are required, (patients) return to work, there is better cognitive function, return of fertility, it is far less expensive and it is what patients want,” she said.
The Irish Kidney Association has continued to highlight the difficulties for patients on haemodialysis who have to travel long distances for their treatment.
The Association described as “deplorable” the fact that the Mid Western Regional Hospital recently could not accept any new patients, as the Limerick dialysis unit is the busiest in the country.
There have also been ongoing delays with the provision of dialysis services to patients in the south east.